[Objective]To establish a risk recognition model for coronary artery stenosis by using a machine learning method and to identify the key causative factors.[Methods]Patients aged≥18 years,diagnosed with coronary heart disease through coronary angiography from January 2013 to May 2020 in two prominent hospitals in Shanxi Province,were continuously enrolled.Logistic regression,back propagation neural network(BPNN),and random forest(RF)algorithms were used to construct models for detecting the causative factors of coronary artery stenosis.Sensitivity(TPR),specificity(TNR),accuracy(ACC),positive predictive value(PV+),negative predictive value(PV-),area under subject operating characteristic curve(AUC),and calibration curve were used to compare the discrimination and calibration performance of the models.The best model was then employed to predict the main risk variables associated with coronary stenosis.[Results]The RF model exhibited superior comprehensive performance compared to logistic regression and BPNN models.The TPR values for logistic regression,BPNN,and RF models were 75.76%,74.30%,and 93.70%,while ACC values were 74.05%,72.30%,and 79.49%,respectively.The AUC values were:logistic regression 0.739 9;BPNN 0.723 1;RF 0.752 2.Manifestations such as chest pains,abnormal ST segments on ECG,ventricular premature beats with hypertension,atrial fibrillation,regional wall motion abnormalities(RWMA)by color echocardiography,aortic regurgitation(AR),pulmonary insufficiency(PI),family history of cardiovascular diseases,and body mass index(BMI)were identified as top ten important variables affecting coronary stenosis according to the RF model.[Conclusions]Random forest model shows the best comprehensive performance in identification and accurate assessment of coronary artery stenosis.The prediction of risk factors affecting coronary artery stenosis can provide a scientific basis for clinical intervention and help to formulate further diagnosis and treatment strategies so as to delay the disease progression.

Lung transplantation is currently the only recognized effective treatment for end-stage lung disease and has improved the quality of life for patients. However, lung transplantation still faces many challenges, including rejection, infection, post-transplant acute kidney injury, post-transplant diabetes mellitus, ischemia-reperfusion injury and donor shortage, etc. Chinese lung transplantation scholars made a series of important progress in the field of clinical research in 2024, focusing on the study and solution of the above problems, and providing new ideas for lung transplantation surgery. This article systematically reviews the clinical research and technological innovation in the field of lung transplantation in 2024, summarizes the achievements of clinical research in the field of lung transplantation in China in 2024, and aims to providing new directions and strategies for future research.

Objective: To explore the cross sectional and longitudinal associations between 24 hour movement behaviors and physical fitness in preschool children, and to adopt the method of equal time substitution analysis to evaluate the impact of time redistribution of different activity behaviors on physical fitness scores,so as to provide a scientific basis for promoting the health of preschool children. Methods: A total of 193 preschool children aged 3-6 years were selected from three Shanghai districts (Jing an, Baoshan, Jiading) from October to December 2023 by the stratified cluster random sampling method. The 24 hour movement behaviors were monitored via 7 day accelerometry, and physical fitness was measured according to the National Physical Fitness Measurement Standards (Revised 2023, preschool section). From October to December 2024, the follow up of physical fitness among preschool children used the same testing method. The comparison between groups was conducted by t-test. Compositional regression analyses evaluated the relationship of 24 hour movement behaviors and physical fitness among preschool children. Results: At baseline, moderate to vigorous physical activity (MVPA) time was significantly higher in boys [(84.10±25.78)min/d] than in girls [( 70.44± 25.98)min/d]; the composite physical fitness score was significantly higher in boys (71.65±8.69) than in girls (68.84±9.89), and the differences were statistically significant ( t =3.65, 2.10, both P <0.01). After adjusting for gender, age and body mass index, the results of component multiple linear regression analysis showed that MVPA time proportion was positively correlated with the composite physical fitness score at baseline among preschool children ( β =6.61), but was negatively correlated with two legged continuous hopping time at 1 year ( β =-1.12) (both P <0.05). Light physical activity (LPA) time proportion was negatively correlated with walking on the balance beam time at 1 year ( β =-4.44), and sedentary behavior (SB) time proportion was negatively correlated with the composite score of physical fitness at baseline ( β =-6.55) (both P <0.05). Isotemporal substitution analysis revealed that replacing 10 minutes of sleep (SP), SB, and LPA with MVPA increased the baseline physical fitness composite score by 0.750, 0.689 and 0.575 units, respectively; at 1 year follow up, the composite score increased by 1.440, 1.419 and 1.430 units, respectively (all P <0.05). Conversely, replacing MVPA with 10 minutes of SP, SB, and LPA,resulted in decreases in baseline physical fitness composite scores of 0.836, 0.777 and 0.669 units, and reductions of 1.613, 1.592 and 1.598 units at 1 year follow up (all P < 0.05 ). Conclusions Preschool children s 24 hour movement behaviors, especially MVPA, are closely related to physical health. Implementing appropriate strategies to increase physical activity and reduce sedentary time may improve the physical fitness of preschoolers.

Objective To assess the clinical value of a novel surgical technique—Tubeless subxiphoid uniportal video-assisted thoracoscopic surgery with percutaneous suspension technique via balance-shaped sternal elevation device in the resection of anterior mediastinal masses. Methods Patients who underwent tubeless subxiphoid uniportal video-assisted thoracoscopic surgery via balance-shaped sternal elevation device in anterior mediastinal masses process at the Department of Thoracic Surgery, West China Hospital, Sichuan University from March to April 2025 were included, and their clinical data were analyzed. Results A total of 4 patients were included, with 2 males and 2 females, aged 58-75 years. The diameter of the tumor was 2.5-3.0 cm. The operation time was 60.0-150.0 min, intraoperative blood loss was 5-10 mL, pain score on the 3rd day after surgery was 0 points, and postoperative hospital stay was 2-3 days. All patients achieved complete resection of the masses and thymus without perioperative complications. Conclusion The tubeless subxiphoid uniportal video-assisted thoracoscopic surgery with percutaneous suspension technique via balance-shaped sternal elevation device technique optimizes surgical visualization and instrument maneuverability while avoiding complications related to conventional anesthesia and tubing, thereby markedly enhancing the minimally invasive profile of anterior mediastinal masses resections. In addition to maintaining procedural safety, this approach effectively reduces postoperative pain and accelerates patient recovery, highlighting its potential for widespread clinical adoption.

Objective:To investigate the feasibility and safety of implementing a domestic vehicle-mounted remote mobile robotic surgical system in thyroid surgery applications, integrated with 5G communication technology.Methods:Using the main system located on the vehicle-mounted mobile robot operating platform of the 960th Hospital of PLA Joint Logistics Support Force and the slave system of Weifang Traditional Chinese Hospital, the remote radical thyroidectomy 5G communication technology, and analyze the clinical and information transmission data of two female patients who underwent remote mobile robot thyroid cancer surgery on October 21, 2024 at Weifang Traditional Chinese Medicine Hospital.Results:The remote radical thyroidectomy was conducted by the robosurgeons utilizing a vehicle-mounted mobile robotic surgical system, and the procedure was successfully completed without necessitating intermediate open surgery. The operation durations for patient 1 and patient 2 were 135 minutes and 108 minutes, respectively, with 7 and 13 lymph nodes dissected, respectively. The average delay in surgical data transmission was recorded at 61.9 milliseconds, with no instances of signal interruption or frame loss. The procedure proceeded smoothly, without any jamming, and the audio and video transmissions were consistently clear. Follow up for 21 days after surgery showed no complications such as hoarseness, skin damage, or lymphatic fistula.Conclusion:The implementation of a vehicle-mounted remote mobile robotic surgery system for thyroid surgery has demonstrated safety and feasibility. Furthermore, the utilization of the 5G network offers rapid data transmission and minimal latency, closely approximating the therapeutic efficacy of traditional robotic thyroidectomy.

Objectives:To investigate the epidemiological characteristics and ethnic differences of cardiovascular-kidney-metabolic syndrome(CKM)among the Hani,Dai,Bai,and Lisu populations in Yunnan Province,and to provide evidence for developing effective prevention and control strategies for CKM.Methods:A cross-sectional survey was conducted among four ethnic minority groups.A total of 3 906 permanent residents aged 18 years and older were enrolled using a multistage cluster random sampling method.CKM stages(0-4)were defined based on the 2023 American Heart Association criteria,stages 3-4 were classified as advanced CKM.Descriptive statistics and chi-square tests were used to compare the prevalence of CKM stages across ethnic groups.Modified Poisson regression was applied to estimate relative risk(RR)and 95%confidence intervals(CI)for factors associated with advanced CKM.Results:The prevalence rates of CKM stage 1 and above among the Hani,Dai,Bai and Lisu ethnic groups were 80.1%,87.3%,84.8%and 67.8%,respectively.The prevalence of CKM was generally higher in males than in females,and the prevalence of CKM increased significantly with age.The Dai ethnic group had the highest prevalence of advanced CKM(24.7%,95%CI:22.1%-27.4%),while the Lisu ethnic group had the lowest prevalence of advanced CKM(13.7%,95%CI:11.5%-15.9%).Modified Poisson regression analysis showed that older age and higher body mass index were common risk factors for advanced CKM across all four ethnic groups.Additionally,except for the Lisu ethnic group,the other three ethnic groups had specific individual risk factors:among the Hani ethnic group,low educational attainment(RR=2.18,95%CI:1.12-4.25)and low income(RR=1.47,95%CI:1.00-2.18)were the primary risk factors of CKM.Among the Dai ethnic group,smoking(RR=1.60,95%CI:1.07-2.37)and a family history of cardiovascular disease(RR=1.61,95%CI:1.14-2.27)are the primary risk factors of CKM.Among the Bai ethnic group,male gender(RR=0.48,95%CI:0.29-0.79)was the primary risk factor of CKM.Conclusions:The prevalence of CKM stage 1 or higher is relatively high among the four minority ethnic groups in Yunnan province.There are significant differences in staging characteristics and primary risk factors across ethnic groups,necessitating the development of stratified,differentiated intervention strategies to achieve precise prevention and control and ethnic health equity in terms of CKM.

Objective:To investigate the prevalence, comorbidity patterns, and associated factors of cardiometabolic multimorbidity (CMM) in China.Methods:From 2012 to 2015, a total of 34 994 residents aged ≥35 years were enrolled using a stratified multistage random sampling method across 31 provinces, autonomous regions, and municipalities in China. Data were collected through questionnaires, covering demographic characteristics, behavioral and lifestyle factors, and self-reported history of cardiometabolic diseases. CMM was defined as the coexistence of two or more cardiometabolic diseases in the same individual. Association rule analysis using the Apriori algorithm from the arules package was employed to identify strong CMM patterns. Multivariable logistic regression was employed to explore factors associated with CMM.Results:The mean age of the participants was 55.6 years. Among them, 15 926 were male (45.51%). The prevalence of cardiometabolic multimorbidity (CMM) was 11.25% (3 937/34 994). A total of 35 distinct CMM combinations (each with a frequency ≥10) were identified. The most prevalent dyad, triad, and tetrad comorbidity patterns were hypertension+hyperlipidemia (1 036 cases), hypertension+hyperlipidemia+diabetes (352 cases), and hypertension+stroke+hyperlipidemia+diabetes (54 cases), respectively. Nine strong CMM patterns were identified using the Apriori association rule algorithm. Multivariable logistic regression analysis showed that older age (≥70 years: OR=17.39,95% CI 13.92-21.71, P<0.01), junior high school education ( OR=1.31, 95% CI 1.17-1.48, P<0.01), senior high school or above education ( OR=1.45, 95% CI 1.27-1.65, P<0.01), retirement ( OR=3.09, 95% CI 2.76-3.46, P<0.01), unemployment or being laid-off ( OR=1.16, 95% CI 1.06-1.28, P<0.01), a family history of cardiometabolic disease ( OR=4.37, 95% CI 4.04-4.72, P<0.01), regular smoking ( OR=1.38, 95% CI 1.24-1.53, P<0.05), and occasional smoking ( OR=1.21, 95% CI 1.00-1.49, P<0.01) were significantly associated with an increased risk of CMM. Conclusion:The prevalence of cardiometabolic multimorbidity in China is relatively high, with the most common comorbidity patterns involving combinations of hypertension and hyperlipidemia, often accompanied by diabetes and stroke. Older age, retirement status, smoking, and a family history of cardiovascular disease are associated with an increased risk of both single and multiple cardiometabolic conditions. Greater attention should be paid to individuals with a single cardiometabolic disorder due to their elevated risk of developing multimorbidity.

Objectives:To investigate the epidemiological characteristics and ethnic differences of cardiovascular-kidney-metabolic syndrome(CKM)among the Hani,Dai,Bai,and Lisu populations in Yunnan Province,and to provide evidence for developing effective prevention and control strategies for CKM.Methods:A cross-sectional survey was conducted among four ethnic minority groups.A total of 3 906 permanent residents aged 18 years and older were enrolled using a multistage cluster random sampling method.CKM stages(0-4)were defined based on the 2023 American Heart Association criteria,stages 3-4 were classified as advanced CKM.Descriptive statistics and chi-square tests were used to compare the prevalence of CKM stages across ethnic groups.Modified Poisson regression was applied to estimate relative risk(RR)and 95%confidence intervals(CI)for factors associated with advanced CKM.Results:The prevalence rates of CKM stage 1 and above among the Hani,Dai,Bai and Lisu ethnic groups were 80.1%,87.3%,84.8%and 67.8%,respectively.The prevalence of CKM was generally higher in males than in females,and the prevalence of CKM increased significantly with age.The Dai ethnic group had the highest prevalence of advanced CKM(24.7%,95%CI:22.1%-27.4%),while the Lisu ethnic group had the lowest prevalence of advanced CKM(13.7%,95%CI:11.5%-15.9%).Modified Poisson regression analysis showed that older age and higher body mass index were common risk factors for advanced CKM across all four ethnic groups.Additionally,except for the Lisu ethnic group,the other three ethnic groups had specific individual risk factors:among the Hani ethnic group,low educational attainment(RR=2.18,95%CI:1.12-4.25)and low income(RR=1.47,95%CI:1.00-2.18)were the primary risk factors of CKM.Among the Dai ethnic group,smoking(RR=1.60,95%CI:1.07-2.37)and a family history of cardiovascular disease(RR=1.61,95%CI:1.14-2.27)are the primary risk factors of CKM.Among the Bai ethnic group,male gender(RR=0.48,95%CI:0.29-0.79)was the primary risk factor of CKM.Conclusions:The prevalence of CKM stage 1 or higher is relatively high among the four minority ethnic groups in Yunnan province.There are significant differences in staging characteristics and primary risk factors across ethnic groups,necessitating the development of stratified,differentiated intervention strategies to achieve precise prevention and control and ethnic health equity in terms of CKM.

Objective:To investigate the prevalence, comorbidity patterns, and associated factors of cardiometabolic multimorbidity (CMM) in China.Methods:From 2012 to 2015, a total of 34 994 residents aged ≥35 years were enrolled using a stratified multistage random sampling method across 31 provinces, autonomous regions, and municipalities in China. Data were collected through questionnaires, covering demographic characteristics, behavioral and lifestyle factors, and self-reported history of cardiometabolic diseases. CMM was defined as the coexistence of two or more cardiometabolic diseases in the same individual. Association rule analysis using the Apriori algorithm from the arules package was employed to identify strong CMM patterns. Multivariable logistic regression was employed to explore factors associated with CMM.Results:The mean age of the participants was 55.6 years. Among them, 15 926 were male (45.51%). The prevalence of cardiometabolic multimorbidity (CMM) was 11.25% (3 937/34 994). A total of 35 distinct CMM combinations (each with a frequency ≥10) were identified. The most prevalent dyad, triad, and tetrad comorbidity patterns were hypertension+hyperlipidemia (1 036 cases), hypertension+hyperlipidemia+diabetes (352 cases), and hypertension+stroke+hyperlipidemia+diabetes (54 cases), respectively. Nine strong CMM patterns were identified using the Apriori association rule algorithm. Multivariable logistic regression analysis showed that older age (≥70 years: OR=17.39,95% CI 13.92-21.71, P<0.01), junior high school education ( OR=1.31, 95% CI 1.17-1.48, P<0.01), senior high school or above education ( OR=1.45, 95% CI 1.27-1.65, P<0.01), retirement ( OR=3.09, 95% CI 2.76-3.46, P<0.01), unemployment or being laid-off ( OR=1.16, 95% CI 1.06-1.28, P<0.01), a family history of cardiometabolic disease ( OR=4.37, 95% CI 4.04-4.72, P<0.01), regular smoking ( OR=1.38, 95% CI 1.24-1.53, P<0.05), and occasional smoking ( OR=1.21, 95% CI 1.00-1.49, P<0.01) were significantly associated with an increased risk of CMM. Conclusion:The prevalence of cardiometabolic multimorbidity in China is relatively high, with the most common comorbidity patterns involving combinations of hypertension and hyperlipidemia, often accompanied by diabetes and stroke. Older age, retirement status, smoking, and a family history of cardiovascular disease are associated with an increased risk of both single and multiple cardiometabolic conditions. Greater attention should be paid to individuals with a single cardiometabolic disorder due to their elevated risk of developing multimorbidity.

Objectives:To investigate the association between social determinants of health(SDOH)and incident stroke and analyze the main risk factors for stroke among resident with different SDOH levels. Methods:From 2012 to 2015,30 036 residents(≥35 years old)from 30 districts in 14 provincial-level administrative divisions in China were enrolled this study based on stratified multi-stage-random-sampling method.The prevalence of cardiovascular diseases and related risk factors were investigated,and stroke events were followed up in 2018 to 2019.Principal component analysis was performed to establish SDOH scores based on 9 indicators related to socioeconomic and healthcare resources,participants were divided into low SDOH group(n=8 343)when it was≥-2.01 to<-1.14,middle SDOH group(n=7 257)when it was≥-1.14 to<0.10,and high SDOH group(n=8 457)when it was≥0.10 to≤5.79.Multivariate Cox regression was applied to estimate the association of SDOH levels with incident stroke.The random survival forest method was used to analyze the major risk factors in different SDOH levels. Results:A total of 24 057 participants were finally included,669(2.8%)participants developed stroke during a mean of(4.7±0.8)years follow-up.The incidence densities of stroke in the low,medium,and high SDOH groups were 468.39,628.85,and 700.39/100 000 person-years,respectively(Pdifference<0.05,Ptrend=0.01).Compared with individuals with low SDOH level group,fully HR for incident stroke among those with medium and high were 1.91(95%CI:1.54-2.36)and 1.59(95%CI:1.30-1.95),respectively(Ptrend<0.001).Advanced age is the primary risk factor for stroke in the population,especially in districts with high SDOH level.In districts with medium SDOH level,diabetes is an important risk factor for stroke.High blood pressure and alcohol consumption are important modifiable risk factors in low SDOH level districts. Conclusions:Present study shows that higher levels of SDOH are associated with increased risk of stroke.The main risk factors for stroke differ among participants with different SDOH level districts.Targeted interventions should be implemented to improve the prevention and treatment of stroke in populations with different levels of SDOH.